Patient-controlled Epidural Analgesia with Bupivacaine and Fentanyl on Hospital Wards

Liu, Spencer S.; Allen, Hugh W.; Olsson, Gayle L.

doi:10.1097/00000542-199803000-00020

Cited by 219 publications

(126 citation statements)

References 27 publications

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“…The limited segmental spread of the thoracic epidural analgesia also minimizes motor blockade thus facilitating early mobilization. 21 The classic catabolic response to operation (the surgical stress response), a key pathogenic factor in postoperative morbidity, is attenuated by blocking the afferent neural stimulus with epidural local anesthetic. 22 Extensive epidural anesthesia (T4-Ss) is easily achieved by the thoracic route without approaching toxic local anesthetic concentrations and, when instituted before surgery and followed by epidural analgesia with local anesthetic, results in the greatest observed reduction of the perioperative stress response.…”

mentioning

confidence: 99%

Péridurale thoracique: tout ce que nous voulons c’est l’analgésie?

Carli

Klubien

1999

Can J Anesth/J Can Anesth

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mentioning

confidence: 99%

Péridurale thoracique: tout ce que nous voulons c’est l’analgésie?

Carli

Klubien

1999

Can J Anesth/J Can Anesth

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“…Numerous studies have supported the use of PCEA with such solutions. Liu et al [1] studied 1030 patients using PCEA for postoperative pain control and found their mixture of bupivacaine 0.05% and fentanyl 4 mg.ml ¹1 to be safe and effective. Wiebalck et al [2] demonstrated the benefits of adding sufentanil to bupivacaine for postoperative PCEA.…”

Section: Discussionmentioning

confidence: 99%

“…Numerous authors have studied the use of a lipid-soluble opioid and local anaesthetic mixture for postoperative patient-controlled epidural analgesia (PCEA) [1][2][3]. While the use of such solutions has become commonplace, there is still much controversy regarding the use of a background infusion in PCEA for postoperative pain control.…”

mentioning

confidence: 99%

A comparison of patient‐controlled epidural analgesia following gynaecological surgery with and without a background infusion

Wong

Chong

et al. 2000

Anaesthesia

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SummaryWe conducted a randomised, controlled study to investigate the effect of adding a background infusion to patient-controlled epidural analgesia for postoperative pain relief. Forty-two patients scheduled for elective lower abdominal gynaecological surgery received patient-controlled epidural analgesia postoperatively using a mixture of 0.2% ropivacaine and 2.0 mg.ml ¹1 fentanyl. Patients in group B (n ¼ 20) were given a background infusion of 5 ml.h ¹1 , whereas those in group N (n ¼ 21) were not. There was no difference in pain scores or patient satisfaction scores between the two groups. Patients in group B had a higher total drug consumption (156.8 Ϯ 34.8 ml vs. 89.5 Ϯ 41.0 ml; p < 0.0001) and incidence of side-effects (71.4% vs. 30.0%; p ¼ 0.007). Motor blockade during the 24-h study period was also greater in group B (median [range] area under the curve 7.5 [0.0-39.0] h vs. 3.0 [0.0-36.0] h; p ¼ 0.035). We conclude that the addition of a background infusion to patient-controlled epidural anaesthesia is not recommended as it confers no additional benefits.

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“…3 Ac cor ding to se ve ral studi es, TE A using a lo cal ana est he tic com bi ned with an opi o id can be con si de red as a com monly used stan dard met hod in the ma na ge ment of acu te posttho ra co tomy pa in. [4][5][6] The ma jo rity of stu di es ha ve shown that the use of a lo cal ana est he tic-opi o id com bi na ti on is as so ci a ted with sig ni fi cantly bet ter dyna mic pa in re li ef af ter tho ra cic sur gery than the com po nents of the mix tu re in fu sed alo ne. 3 The aim of pos to pe ra ti ve pa in ma na ge ment is to pro vi de go od sub jec ti ve com fort, to con tri bu te early re co very and to have a go od out co me af ter sur gery.…”

Section: Effects Of Preoperatively or Postoperatively Initiated Thoramentioning

confidence: 99%

Effects of Preoperatively or Postoperatively Initiated Thoracic Epidural Analgesia in Patients Undergoing Elective Lung Surgery

Çöçelli¹,

Sarimehmetoğlu²,

Demiryürek³

et al. 2010

Turkiye Klinikleri J Med Sci

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A AB BS S T TR RA AC CT T O Ob b j je ec c t ti i v ve e: :The go al of this study was to in ves ti ga te the ef fects of pre o pe ra ti vely and pos tope ra ti vely ini ti a ted tho ra cic epi du ral anal ge si a (TE A) on oxi da ti ve stress, res pi ra tory func ti ons and pos to pe ra ti ve pa in in pa ti ents un der go ing elec ti ve lung sur gery. M Ma a t te e r ri i a al l a an nd d M Me et t h ho od ds s: : A tho ra cic epi du ral cat he ter was in ser ted in to all the pa ti ents be fo re sur gery. In Pre op-TE A Gro up (n= 15), bo lus do se of 0.175% bu pi va ca i ne and 15 µg ml -1 fen tanyl (0.1 ml kg -1 ) were ad mi nis te red pre o pe ra ti vely, fol lo wed by a con ti nu o us in fu si on of 0.125% bu pi va ca i ne and 10 µg ml -1 fen tanyl com bi na ti on (0.1 ml kg -1 h -1 ) in trao pe ra ti vely. In Pos top-TE A Gro up (n= 15), no me di ca ti on was ad mi nis te red vi a the epi du ral cat he ter pre o pe ra ti vely. Pos to pe ra ti ve anal ge si a was ma in ta i ned with pa ti ent-con trol led epi du ral anal ge si a (PCA) in both gro ups for 48 h. We as ses sed pe ro pe ra ti ve IV anal ge sic re qu irt ment and pos to pe ra ti ve pa in and anal ge sic con sump ti on, oxi da ti ve stress, he art ra te, blo od pres su re, res pi ra tory func ti ons and si de ef fects. The pos to pe ra ti ve in ten si ve ca re unit and hos pi tal stay du ra ti ons we re re cor ded. Stu dent's t-test, χ 2 -test, Mann-Whit ney U test, and Wil co xon's sig ned rank test we re used for gro up com pa ri sons and sta tis ti cal conc lu si ons. R Re e s su ul lt ts s: : Vi su al ana lo gu e sco res we re al ways hig her du ring co ug hing and at rest, pe ri o pe rati ve he art ra te was increased in Pos top-TE A Gro up (p< 0.05). To tal pe ro pe ra ti ve fen tanyl re qu i re ment and pos to pe ra ti ve anal ge sic con sump ti on vi a PCA we re lo wer in Pre op-TE A Gro up (p< 0.05). Res pi ra tory func ti on tests we re dec re a sed in both gro ups when com pa red to the pre o pe ra ti ve va lu es (p< 0.05), but the dif fe ren ces we re small in Preop-TEA group (p< 0.05). No mar ked ef fect on oxi da ti ve stress was determined and shor ter length of stay in ICU and hos pi tal shorter in Pre op-TE A Gro up (p< 0.05). C Co on nc c l lu u s si i o on n: : The se re sults sug gest that pre o pe ra ti vely ini ti a ted TE A pro vi des bet ter pos to pe ra ti ve pa in re li ef with impro ving the out co me and shor te ning in ten si ve ca re and hos pi tal stay in pa ti ents un der go ing elec ti ve lung sur gery. Ho we ver, TE A had no mar ked ef fect on oxi da ti ve stress in our study. K Ke ey y W Wo or rd ds s: : Anal ge si a, epi du ral; tho ra co tomy; pa in, pos to pe ra ti ve; oxi da ti ve stress Ö ÖZ ZE ET T A Am ma aç ç: : Bu ça lış ma nın ama cı elek tif ak ci ğer cer ra hi si olan has ta lar da ok si datif stress, so lu num fonksi yon la rı ve pos to pe ra tif ağ rı üze ri ne pre o pe ra tif ve pos to pe ra tif baş la tı lan to ra sik epi du ral anal je zi nin (TE A) et ki le ri ni araş tır mak tı. G Ge er re eç...

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Patient-controlled Epidural Analgesia with Bupivacaine and Fentanyl on Hospital Wards

Abstract: Patient-controlled epidural analgesia provides effective and safe postoperative analgesia on hospital wards.

Cited by 219 publications

References 27 publications

Péridurale thoracique: tout ce que nous voulons c’est l’analgésie?

Péridurale thoracique: tout ce que nous voulons c’est l’analgésie?

A comparison of patient‐controlled epidural analgesia following gynaecological surgery with and without a background infusion

Effects of Preoperatively or Postoperatively Initiated Thoracic Epidural Analgesia in Patients Undergoing Elective Lung Surgery

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